Veterans Special Report

News & Research

Hyperbaric Oxygen Therapy has been used for the better part of two centuries. Search our  arhives below for past HBOT news and research or scroll down for the latest.

The Latest HBOT News & Research

Clinical Trial – Intrathecal Neostigmine for Prevention of PDPH

Jun 13, 2018 | , ,

Neuraxial blocks continue to be the cornerstone of anesthesia and postoperative analgesia for
normal vaginal delivery and elective caesarean section due to its approved safety and
efficiency for decades. Post-dural puncture headache (PDPH) is still one of the most common
complications of neuraxial anesthetic techniques. The headache could be severe and limit the
activities of the new mother to care for her baby, prolong hospital stay.

PDPH is defined as a headache that develops within five days of dural puncture and can’t be
attributed to any other types of headache and mostly is postural in character.

Neostigmine methylsulfate is a synthetic carbamic acid ester which reversibly inhibits the
enzyme Acetylcholine esterase (AChE) that makes more Acetylcholine molecules available at
cholinergic receptors. Neostigmine is used in anesthesia mainly as a reversal for
non-depolarizing neuromuscular agents.

Intrathecal (IT) neostigmine was tried as an adjuvant to local anesthetics in IT block for
elective cesarean sections to decrease local anesthetic consumption and to prolong
postoperative analgesia. Side effects of IT neostigmine are dose-dependent with doses more
than 25 µg especially nausea and vomiting and could be decreased by increasing the baricities
of the local anesthetic solutions and by early head up position after IT injection. However,
its effect on PDPH was not investigated before in literature.

Parturients will be randomly assigned into one of two groups: the intervention group will
receive 20 µg with IT Bupivacaine and the control group will receive an equivalent volume of
dextrose 5% with the IT Bupivacaine.

The objective of the current study is to evaluate the efficacy and safety of IT neostigmine
as an adjuvant to bupivacaine in reducing the incidence and severity of post-dural puncture
headache in parturients scheduled for an elective cesarean section.

Evidence brief: hyperbaric oxygen therapy (HBOT) for traumatic brain injury and/or post-traumatic stress disorder.

Jun 12, 2018 | , ,

This report is a product of the VA Evidence-based Synthesis Program. The purpose is to provide “timely and accurate syntheses of targeted healthcare topics. to improve the health and healthcare of Veterans”. The authors have made a comprehensive search and analysis of the literature and make recommendations to assist clinicians in dealing with veterans suffering from either traumatic brain injury (TBI) or post-traumatic stress disorder (PTSD). The report is timely and of great potential impact given the vigorous and lengthy debate among hyperbaric physicians and lay people determined to find an answer for the large numbers of veterans deeply affected with some combination of PTSD and post-concussion dysfunction.